Estimates of cancer incidence and mortality in Europe in 1995

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Abstract

Cancer incidence and mortality estimates for 1995 are presented for the 38 countries in the four United Nations-defined areas of Europe, using World Health Organization mortality data and published estimates of incidence from national cancer registries. Additional estimation was required where national incidence data was not available, and the method involved incorporating the high quality incidence and mortality data available from the expanding number of population-based cancer registries in Europe. There were an estimated 2.6 million new cases of cancer in Europe in 1995, representing over one-quarter of the world burden of cancer. The corresponding number of deaths from cancer was approximately 1.6 million. After adjusting for differing population age structures, overall incidence rates in men were highest in the Western European countries (420.9 per 100 000), with only Austria having a rate under 400. Eastern European men had the second highest rates of cancer (414.2), with extremely high rates being observed in Hungary (566.6) and in the Czech Republic (480.5). The lowest male all-cancer rate by area was observed in the Northern European countries, with fairly low rates seen in Sweden (356.6) and the UK (377.8). In contrast to men, the highest rates in women were observed in Northern Europe (315.9) and were particularly high in Denmark (396.2) and the other Nordic countries excepting Finland. The rates of cancer in Eastern European women were lower than in the other three areas, although as with men, female rates were very high in Hungary (357.2) and in the Czech Republic (333.6). There was greater disparity in the mortality rates within Europe—generally, rates were highest in Eastern European countries, notably in Hungary, reflecting a combination of poorer cancer survival rates and a higher incidence of the more lethal neoplasms, notably cancer of the lung. Lung cancer, with an estimated 377 000 cases, was the most common cancer in Europe in 1995. Rates were particularly high in much of Eastern Europe reflecting current and past tobacco smoking habits of many of its inhabitants. Together with cancers of colon and rectum (334 000), and female breast (321 000), the three cancers represented approximately 40% of new cases in Europe. In men, the most common primary sites were lung (22% of all cancer cases), colon and rectum (12%) and prostate (11%), and in females, breast (26%), colon and rectum (14%) and stomach (7%). The number of deaths is determined by survival, as well as incidence; by far the most common cause of death was lung cancer (330 000)—about one-fifth of the total number of cancer deaths in Europe in 1995. Deaths from cancers of the colon and rectum (189 000) ranked second, followed by deaths from stomach cancer (152 000), which due to poorer survival ranked higher than breast cancer (124 000). Lung cancer was the most common cause of death from cancer in men (29%). Breast cancer was the leading cause of death in females (17%). Cancer registries are a unique source of information on cancer incidence and survival, and are used here with national mortality to demonstrate the very substantial burden of cancer in Europe, and the scope for prevention. Despite some provisos about data quality, the general patterns which emerge in Europe verify the role of past exposures and interventions, and more importantly, firmly establish the need for cancer control measures which target specific populations. In particular, there is a clear urgency to combat the ongoing tobacco epidemic, now prevalent in much of Europe, particularly in the Eastern countries.

Introduction

Over one-quarter of the global burden of cancer occurs within Europe despite the fact that Europe's inhabitants comprise only approximately one-eighth of the world's population. The major public health challenges arising from an increasing cancer burden in Europe led the European Commission in 1987 to establish a collaborative policy on cancer control. The ‘Europe Against Cancer Programme’ identified four separate areas for action, namely data collection and research, information and health education, early detection and screening, and training and quality control.

The European Network of Cancer Registries (ENCR) is one of the main activities within the first area of the Programme, and seeks to improve the quality, comparability and availability of cancer data, promote their use in cancer control, healthcare planning and research, and provide regular information on the burden of cancer in Europe. Currently, the ENCR has a membership of 152 population-based cancer registries, who regularly submit information on the incidence and mortality of cancer in their catchment area to the ENCR secretariat, housed in the International Agency for Research on Cancer (IARC). The data are then formatted and included in the latest version of the EUROCIM software package [1]. EUROCIM provides ENCR members with a resource to compare their own incidence and mortality datasets with data from other European cancer registries, and a fundamental aim of the software tool is to promote communication and collaboration between members on issues such as data quality and cancer research. At present, approximately 30% of the European population of over 700 million reside in areas covered by cancer registries.

This paper examines the geographical variations in cancer burden and risk in 1995 in the European countries within the four United Nations (UN) defined regions (Eastern, Northern, Southern and Western Europe) using the most recent incidence and mortality data. To do this, we have complemented reported incidence figures from nationwide cancer registries and mortality data from the World Health Organization (WHO), with national estimates obtained using a method which incorporates the high-quality incidence and mortality data available from the cancer registries of Europe.

This report follows the methodology and style of presentation of several previous publications examining cancer burden in the European Union in 1980 [2] and 1990 [3]. The motivation behind this set of estimates for 1995 is the availability of more up-to-date information on cancer incidence and mortality in EUROCIM [1], as well as recent datasets published by national cancer registries. As part of the ‘Europe Against Cancer’ Programme, the ENCR is continually expanding, improving the quality of information on cancer burden in areas where previously less was known, such as in Eastern Europe. For the first time, we can provide estimates of the cancer incidence and mortality for the whole of Europe, using a consistent methodology, incorporating the many local and national cancer data sources available.

Section snippets

Patients and methods

Cancer incidence and mortality estimates in 1995 are reported for the 38 countries in the four areas of Europe for which the UN supplies population estimates and projections. Details are provided in the map of Europe (Fig. 1). Incidence and mortality data are summarised for 25 common cancer sites, together with an estimate of all cancers combined (excluding non-melanoma skin cancer, ICD-9 140–172, 174–208). The primary cancers considered are oral cavity (ICD-9 140–145), nasopharynx (147), other

Results

Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8, Fig. 9, Fig. 10, Fig. 11, Fig. 12, Fig. 13, Fig. 14, Fig. 15, Fig. 16, Fig. 17, Fig. 18, Fig. 19, Fig. 20, Fig. 21, Fig. 22, Fig. 23, Fig. 24, Fig. 25, Fig. 26, Fig. 27, Fig. 28, Fig. 29, Fig. 30, Fig. 31, Fig. 32, Fig. 33, Fig. 34, Fig. 35, Fig. 36, Fig. 37, Fig. 38, Fig. 39, Fig. 40, Fig. 41, Fig. 42, Fig. 43, Fig. 44, Fig. 45, Fig. 46, Fig. 47 display the sex-specific incidence and mortality rates (age-standardised using the European

Discussion

This study provides an overview of the cancer incidence and mortality in European countries, documenting the extent of disease burden and the variations in the risk of developing and dying from cancer. The methodology is consistent with previous studies estimating cancer incidence within the European Union 2, 3, 7.

Several sources of data have been used in generating the statistics—for some countries, national incidence was available from national registries, for others, it was necessary to

Acknowledgements

The research was undertaken with the support of the European Network of Cancer Registries project of the European Commission, Grant No. S12.299682 (2000CVG2—020). The estimates were made using incidence and mortality data from the EUROCIM database of the European Network of Cancer Registries. The contributions of the individual registries is gratefully acknowledged—a list of ENCR Members is attached as an Appendix. We would also like to thank Maria de Ia Trinidad Valdivieso Gonzalez of the Unit

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